Creating The Most Comprehensive Long-Term Care Database

Main Category: Seniors / Aging
Also Included In: Caregivers / Homecare;  IT / Internet / E-mail;  Alzheimer's / Dementia
Article Date: 16 Nov 2007 - 1:00 PDT

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More than 1.4 million Americans live in nursing homes today. By 2020, an estimated 12 million will need long-term care, whether in a nursing home, assisted living facility, chronic care hospital or from an at-home health service provider.

At this time of skyrocketing demand for long-term care, the National Institute on Aging has awarded Brown University a major grant to create the first research database aimed at improving the nation's long-term care system -- and the lives of the elderly who rely on that system to eat, take medications and carry out other tasks of daily living.

Vincent Mor, chairman of the Department of Community Health at Brown and a member of the University's Center for Gerontology and Health Care Research, is principal investigator on the five-year, $10-million grant. Mor and his team will take existing federal data on Medicare reimbursement claims, patient hospitalization rates and other data and combine it with new information the team will collect on the health status of residents, reimbursement rates for long-term care services, the organization of those services, and other topics from a random sample of 2,600 nursing homes across the country. The group will also collect information on relevant policies from all 50 states.

The goal: Allow researchers to trace a clear relationship among state policies, local market forces and the quality of long-term care. Policy-makers can then use the information to craft state and local guidelines that promote high-quality, cost-effective, equitable care for older Americans.

"At the end of this project, we'll have the single-most comprehensive data set on long-term care in the United States," Mor said. "This storehouse of data will be used, ultimately, to shape policies that improve the health of older Americans."

The grant will support four projects, each run by researchers in Brown's nationally recognized Center for Gerontology and Health Care Research. The projects will help researchers:

* understand how state policies and regional differences in medical treatment affect the frequency with which residents in long-term care settings are hospitalized for conditions such as hip fracture and Alzheimer's disease;

* pinpoint the effects of racial segregation on nursing home quality of care;

* identify the policy and market forces that dictate the organization of medical staff support in nursing homes; and

* track state policy changes over a 10-year period and their effect on the use of hospice and other forms of palliative care in nursing homes.

"Most of us will need some form of long-term care during our lives, whether that's the occasional assistance of a home health nurse or the constant care of nursing home staff," said Terrie "Fox" Wetle, associate dean of medicine for public health and public policy at Brown and a lead investigator on the NIA project. "We want to be sure that the elderly are getting the best care possible. One way to do that is to craft sound state policies, policies based on real, reliable data on reimbursement rates, staffing patterns and other factors that directly affect long-term care quality."

John Haaga, deputy director of the Behavioral and Social Research Program at the National Institute on Aging, a component of the National Institutes of Health, said that when Brown's database is complete in 2012, it will be the first to track nursing home performance and policy on a state level for all 50 states. The project's ambitious nature is just one reason it was funded, Haaga said.

Brown's 20-year, trailblazing track record on nursing home policy and end-of-life care research was also a factor in the award, along with the multidisciplinary, cross-institutional nature of the project. Mor recruited two preeminent Brown social scientists -- Andrew Foster, professor and chairman of the Department of Economics, and John Logan, professor of sociology and director of the Spatial Structures in the Social Sciences research initiative -- to join his team. Mor is also partnering with researchers from Dartmouth College and the University of Rochester, who will help create and manage the long-term care database.

"This is strong science led by first-class researchers," Haaga said, "and the public should see the benefits from this project not in 20 years, but in five. This policy-relevant research goes directly to the institute's mission to support science that can inform our decisions about an aging society."

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Source: Wendy Lawton
Brown University

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